WHEN E. coli in spinach makes hundreds of people sick, the Centers for Disease Control and Prevention is all over it.

But when millions of people get diseases every year from the same bugs spilling into our waterways from broken sewage pipes, the CDC says nothing.

Illegal sewage discharges used to be thought of as an environmental problem.

But that was before recent studies at the EPA and the University of California at Los Angeles showed that sewage-related diseases are now a full blown national health care crisis of epidemic proportions.

In California, UCLA professor Linwood Pendleton estimates that 1.5 million people got sick last year in the Los Angeles area from sewage-related bacteria.

That is 1.5 million diseased people in just one area in one year.

The EPA says nationally 3.5 million people get diseases every year from sewage-born E. coli. In light of the UCLA study, we now know even that number is low. And if one tenth of 1 percent of them died, that's 3,500 dead people a year from sewage related diseases. That's like having 10 E. coli-tainted spinach outbreaks every day.

In Ohio, E. coli bacteria reached dangerous levels in 90 percent of the water samples taken at a national park. In Michigan, some recreational boaters refuse to go into the Great Lakes because too many of them were getting sick.

In San Diego, the emergency rooms are full of surfers who think they have the flu, but who were recently in contact with polluted water.

Hawaii had the worst sewage spill in the history of this country earlier this year when 50 million gallons of untreated sewage was released onto their beaches. One died. Hundreds were sick.

The list goes on and on and on. Last year, the EPA reported there were 73,000 sewer spills in America.

Here's why: Most sewer pipes were built 60 years ago, but meant to last 50 years.

So the E. coli contamination problem is going to get worse and worse as our sewer pipes get older and older.

But the CDC is not even keeping track of the number of sewage related diseases or deaths, much less trying to control or prevent them. And until they change their name, that is part of their mission as the Centers for Disease Control and Prevention, the operative but often forgotten word being prevention.

Oprah Winfrey recently had a show about sewage and water quality that contained more and better information than the CDC web site. If Oprah gets it, why can't the CDC?

As the president and CEO of a company that inspects and repairs more sewer pipes than any in the world, I've seen the problem firsthand.

Some leaders like Mayor Shirley Franklin of Atlanta are seeing sewage for what it is: More of a public health threat to people than an environmental problem about frogs and fishes.

Ms. Franklin calls herself the "Sewer Mayor" because she has embarked on a program to fix Atlanta's broken sewer system and prevent even more sewage related sickness.

In Louisville, they get it too: The city is going to start broadcasting public health alerts on local television when sewer pipes go bad.

But for every leader like Ms. Franklin, hundreds of others ignore sewer pipes until they break, or until people get sick. Then they say they didn't know.

Or it was too expensive. Or the CDC never told them about the link between bad pipes and bad health.

Bogus excuses all. Even so, that is probably better than the CDC's response of institutional ignorance.

There is a whole range of things the CDC can do to respond to this new reality of an epidemic of sewage related diseases. Yes, the EPA does a lot.

But the CDC has to do more as well. The first and most important is let people know they are getting sick, not from some mysterious bug that comes and goes at random, but from the systematic and willful neglect of our sewage infrastructure that is releasing hordes of E. coli bacteria into our water.

A notice from the CDC would attract the attention - and action - that a local news story about a seemingly isolated sewage spill cannot.

Talk is cheap. But it is the best thing the CDC can do right now to react to the most widespread and preventable and ignored public health crisis in America.

One month from now, spinach will be out of the headlines, and sewer pipes will still be breaking at record rates. There is no doubt about that. The only question is whether CDC will start doing something to control and prevent the resulting disease.

Tom Rooney is President and CEO of Insituform Technologies. He lives in Chesterfield, Mo.